Active NPI
Thad Boucher
- Physical Therapist
- McKeesport, PA
National Provider Identifier
1861970451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT026985
- Practice address
- 625 Walnut St
McKeesport, PA 15132-2806 - Phone
- (412) 673-5005
- NPI assigned
- Aug 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT026985 | PA | Primary |
Addresses
Primary practice location
625 Walnut St
McKeesport, PA 15132-2806
Mailing address
21756 State Road 54
Ste 102
Lutz, FL 33549-2905
Phone (727) 475-5540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT026985 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581465600000",
"number": "1861970451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21756 STATE ROAD 54",
"address_2": "STE 102",
"city": "LUTZ",
"state": "FL",
"postal_code": "335492905",
"telephone_number": "727-475-5540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 WALNUT ST",
"city": "MCKEESPORT",
"state": "PA",
"postal_code": "151322806",
"telephone_number": "412-673-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "THAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-06",
"last_updated": "2020-02-12",
"certification_date": "2020-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT026985",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKeesport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.